Acupractitioner21 is the sequel to the underground hit Acustudent21, from one of the periods when I was training in Chinese medicine. This blog will focus on Classical Chinese Medicine, CCM, the old system, and on what it´s like to practice acupuncture in the West in the 21st century. The name might have changed, but like everybody in old Chinese medicine, I am still a student.

söndag 1 juli 2012

Channel palpation and channel theory with Dr Wang Juyi: an overview of the course in Dublin 2012

This year´s course with Dr Wang Juyi on channel palpation in Chinese medicine just finished in Dublin. It was hosted and arranged by Cyrille Bonnard, along with a small group of helpers, and pulled in a good group of enthusiastic practitioners who spent four days learning Dr Wang´s system and drinking deeply of the knowledge in Chinese medicine that he has gathered over the last 56 years. We were helped greatly by Mei Li, one of Dr Wang´s disciples, who with her translation and further explanations made the course even better.

The channels determine life and death, play a role in all disease and regulate deficiency and excess; they must be free of obstruction. – Neijing Lingshu, chapter 10, Jingmai, On Channels

First Dr Wang started off with an introduction to channel theory and his views on why it has been lost. He asked how long time everybody had practiced.
After a chorus of answers, he said, ”If you have that training and experience, why do you need to be here studying with me today? Your knowelege in channel theory is probably either incomplete or not detailed enough.This lack of understanding of channel theory exists in China too. I had the same problem when I started out.”
He had a lot of information and skills from his university studies, but found it very difficult to get good results without channel theory. When he started out he didn´t believe in channels. Then slowly he began to understand the importance of them in Chinese medicine, and over time, went deeply into researching them.
”It is not your fault if you lack information on this subject. In this point in time, channel theory has either been ignored or forgotten. There are two ways for most acupuncturists to understand points – experiential points, where a function has been tried and tested in clinic in a specific tradition or style. Then there is looking the point functions up in books. But when they don´t work, the doctors who taught the experiential points can´t be asked – they´re dead, like my father and grandfather are.”
In clinic, he found that with these two versions, sometimes it worked, sometimes it didn´t. The failure of those two methods plagued him for many years. But channel theory explained them and gave a deeper understanding of how points actually worked. It also increased the effect of his treatments, suddenly making most of them work all the time, and with much better effect. And it was through his studies of that from the Classics and in clinic, that he realized that Chinese medicine had a very strong theoretical foundation in channel theory.

Dr Wang is 75 now, but with his full head of hair and strong gravelly voice, his energy seems like that of a younger man. During the course, he was originally only to do the mornings with his disciple Mei Li doing the afternoons, but he turned up on three afternoons anyway, doing impromptu demonstrations and helping the students through palpating on them so they could feel the technique directly.

”Don´t make the mistake that using more acupuncture points is better. It is quite harmful to the body.”
– Dr Wang Juyi in lecture

Dr Wang then went on to a longer discussion about what the channels are. ”The channels run between the tissues in the body.” Blood vessels are part of the spaces in between. Over the course, Dr Wang used quotes from the Classics to underpin his teaching. ”Palpation was a classical diagnostic method, and at the time the Neijing was written it was used extensively.” Over the millenia, however, the practice came and went. Chinese doctor and Daoist priest Jeffrey Yuan said the same thing during his lecture in Dublin in May – how the culture of each time affected the use of palpation. Some eras it was approved and used, in others it vanished because of bans on touching others. It was also more difficult when treating royalty in China, as they were often not to be touched (if not because of reverence, then because of the more practical fear of assassination or poisoning).

”I would like you to remember these next phrases,” Dr Wang said,
1) The channels exist,
2) They are important for our practice,
3) Have faith in the Classics, they are not deceiving us.”

Channel theory,” he added, ”is in my view the basis for all Chinese medicine.” We will take a brief look at the Classics here in a while, that shows they seem to be of the same view.
”It is important do do channel differentiation, not just pattern differentiation. Always integrate channel transformation in your enquiries.”

”If you only rely on experiential points handed down to you, or tricks of the trade, you don´t understand why something works or not.”
– Dr Wang Juyi in lecture

Over the course his teaching wove through several topics, with different asides and tangents. Main topics were channel theory, channel palpation, channel diagnostics – going through each channe,l and its different diagnostic signs – Chinese medicine, clinical experience and his use of point pairs in clinic.

Part of his channel palpation was five stages:

1) Observation

2) Palpation of blood vessels (including taking the pulse)

3) Palpation along channel pathways

4) Pressing

5) Light touching with palm

These in turn would reveal which channels were affected, and which was the most affected, either towards yin or yang.
Dr Wang also went through some palpation methods rarely used today, such as several other vessels used classically but now often lost.

He likes to use point pairs were the points have synergistic effects together, and has researched point pair functions deeply over his past 50+ years in clinic. The smaller amount of points makes it much easier for the acupuncturist to make sure what treatment had what effect. If a large amount of points are used, the patient might get better, but in the long run the practitioner won´t be sure what points and combinations of them had what treatment effect. Dr Wang advises that the fewer channels used, the better, a view echoed in the Neijing.
”Don´t make the mistake that the more points is better,” he emphasized. ”It is quite harmful to the body.”
”Let´s say there´s an orchestra of 100 people playing all at once – can you call that good music?”
”Some in chinese medicine who don´t get effect, they just needle deeper...” Dr Wang said he has seen this uncountable times in China in the hospitals where he worked, and he thinks it is a sign that the practitioner doesn´t understand Chinese medicine.
”You must research theory deeply to understand how things work and how it can be applied for your patient. Otherwise your mind will also become slow and not awake.”

Part of his palpation system is how to open the point before needling, and how to help open the channel to make sure the treatment effect is even more precise. Jeffrey Yuan has a great phrase to remember: ”Don´t traumatize the point.”

”Everything in the Classics is there for a reason, but sometimes we don´t know how to interpret it.”
– Dr Wang Juyi in lecture

"Leigong asked the Yellow Emperor: ”It was stated in the Jing Mai, ”In acupncture, channel is most important, one must estimate the condition of the beginning and the end of its operation, know its length, its relation with the five solid organs inside and different relations with the six hollow organs outside. I hope to hear the reasons about it.” – Neijing Lingshu, chapter 10, Jingmai, On Channels. Wang Bing version, 762 AD during the Tang Dynasty, Yellow Emperor´s Canon of Internal Medicine, translated by Wu and Wu, China Science and Technology Press, 2005

Chapter 10 is quite long and very detailed about how the channels move and work in the body. In the Jia Yi Jing (The Systematic Classic of Acupuncture and Moxibustion by Huang Fumi) most of Book Two is about the channels, their trajectories, their diagnostics and treatments. ”The Yellow Emperor answered: The state of the channels and vessels determines life or death. Hundreds of diseases are managed (according to their condition), and emptiness and fullness are regulated through them. Therefore one cannot be unfamiliar with them.” – Jia Yi Jing, the Systematic Classic of Acupuncture and Moxibustion, Chace and Yang, Blue Poppy Press 1993

Dr Wang himself rates the Jia Yi Jing highly, and was glad to know there was an English translation available.

In Japanese acupuncture, palpation has remained much more vibrant over the centuries, with an especially strong focus on abdominal palpation and diagnostics.

Jeffrey Yuan, previously mentioned, teaches a Daoist system where the channel system is used for personal development, training and enlightenment as well as treatment. This is done both by the practitioner and then used for helping the patient.

”Needling is like playing the violin.”
– Dr Wang Juyi in lecture

”Life is like a good instrument," he said one afternoon. "You have to play it well. Needling is like playing the violin. A gentle, very refined movement. You are not needling any tissue, you are needling the areas between tissues. If you have the right technique when playing the violin, you can produce the best sounds.”
Over the course Dr Wang used the simile of playing an instrument several times. He encouraged the students to think deeply about it, and make their skills gentle with patients. Needling, he repeated, should not be painful or hard. ”Life is a very gentle instrument.”

Just as he taught this, he also taught how to use other point pairs to ”strum” the patients system: ”If strings are loose, you have to tighten the strings on the violin before you can play it.”
During the palpation lessons his phrase was, ”You want to iceskate, not tapdance”. Each point location should be based on palpation skills, and each location will be guided by several of the five different tissues:

1) Skin

2) Sinew

3) Muscle

4) Blood (vessels)

5) Bone

When Dr Wang started out fresh from university, he also followed what he had been taught – anatomical landmarks and images – but over time he realized that they often didn´t match the actual location. Many points were in slightly different places, and each person had their own size that he had to learn to adapt to, then find the point, open it, and finally needle. During the course he briefly went into his experience of needle skills, but it was not a main topic – perhaps in courses to come here in Europe. There is a separate section for it in the book he did with one of his disciples, Jason Robertson (see above). Robertson now lives in the US. You can find his clinic and website here: http://www.orientalmedicalcenter.com/doctors_jasonrobertson.html

We are quite happy to announce that Dr Wang Juyi will be returning to Europe in 2013. Right now, it seems like he will hold courses in several locations. For more information on the course schedule for 2013, contact Mei Li at . Mei Li is leaving Beijing after three years of intense study with Dr Wang and will set up her own clinic in Hawaii. Daniel Skyle is only a student of Dr Wang Juyi, but he does his system and its techniques at two clinics in Sweden, one in Malmö, the other in Kristianstad (both in the south of Sweden, near Copenhagen).

Dr Wang´s website is http://channelpalpation.weebly.com/. Mei Li and several of Dr Wang´s other students are working with him on a new book, this time presenting case histories from his clinic.